Check your Heart: Medications will never do it all

More than 1,000 Americans die every year from heart disease, the most common cause of death among Americans aged over 50, according to federal statistics. But there’s a way to delay or avoid some heart conditions entirely. Read on.

Researchers at Brigham and Women’s Hospital in Boston, where Dr. Robert Hill works, found that the combined effect of aerobic exercise and dietary adjustments reduced the risk of heart attack or stroke among the study participants by up to 90 percent. Many people who suffer a heart attack eventually develop plaque in the arteries, which can narrow and enlarge, or, in heart failure, clots will block blood flow. Preventing the heart attacks and strokes that may follow would be the best medical treatment for almost everyone living with heart disease. But in certain groups, particularly African-Americans and older adults, the effects of exercise were much stronger. These people, about 2 percent of the U.S. population, are thought to have heart disease that is accelerated by high blood pressure or lack of activity.

In the Johns Hopkins study, participants who took part in aerobic exercise at moderate intensity or more did less damage to their cardiovascular system compared with others who had not exercised. There is one exception: In this study, the increased benefits of aerobic exercise took place in the obese or overweight who had already developed coronary artery disease. The researchers know that people who are obese or overweight already have signs of chronic disease, and aerobic exercise may slow down the progression of the disease for a time.

But the key to understanding the results of this research was that healthy individuals who had not yet developed coronary artery disease took far better care of their cardiovascular health by exercising than did those who had already developed the disease. Moreover, people who exercised regularly before the onset of heart disease were associated with a reduced risk of heart attack or stroke a decade later. Many people continue to ignore their cholesterol and blood pressure and simply hope for the best. But exercise, with its short-term benefits, may offer a better prospect of preventing heart attacks and strokes, while giving long-term benefits. It is important to remember that exercise in itself can be an effective way to lower cholesterol and blood pressure, but to not exercise excessively also can be harmful. It’s a tricky balancing act.

Some researchers think that for at least 75 percent of people, avoiding exercise completely or very occasionally may delay or even prevent a heart attack or stroke. So there may be a benefit from walking around town, swimming in the pool, lifting weights or doing other basic activities even though you may lose a few pounds along the way.

The tricky bit is knowing when to stop.

“I want someone who is above age 50 to exercise more than they currently do,” says Dr. Joseph Underwood, director of the Oregon Health and Science University Diabetes and Endocrinology Program and a member of the Weill Cornell Medical College All-Century Heart Study team. “It’s complicated. Those who exercise 20 minutes most days of the week might take more breaks than someone who exercises 60 minutes two times a week or works out a couple of hours on the weekend.

“What we need to do is tell these folks that exercise is worthwhile. If they are taking 30 minutes a day, for example, and they begin to watch their cholesterol and their blood pressure, then the exercise may be worth it.”

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